Chapter 27 Physiologic Responses of the Newborn to Birth

Chapter 27   Physiologic Responses of the Newborn to Birth

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Respiratory rate of 66 breaths per minute
2. Periodic breathing with pauses of 25 seconds
3. Synchronous chest and abdomen movements
4. Grunting on expiration
5. Nasal flaring

Answer:  2, 4, 5

Explanation:  2. Periodic breathing with pauses longer than 20 seconds (apnea) is an abnormal finding that should be reported to the physician.

4. Grunting on expiration is an abnormal finding that should be reported to the physician.
5. Nasal flaring is an abnormal finding that should be reported to the physician.

Page Ref: 654, 655

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO:  4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

 

2) A 2-day-old newborn is asleep, and the nurse assesses the apical pulse to be 88 beats/min. What would be the most appropriate nursing action based on this assessment finding?

1. Call the physician.
2. Administer oxygen.
3. Document the finding.
4. Place the newborn under the radiant warmer.

Answer:  3

Explanation:  3. An apical pulse rate of 88 beats/min is within the normal range of a sleeping full-term newborn. The average resting heart rate in the first week of life is 110 to 160 beats/min in a healthy full-term newborn but may vary significantly during deep sleep or active awake states. In full-term newborns, the heart rate may drop to a low of 80 to 100 beats/min during deep sleep.

Page Ref: 655

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO:  4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

 

 

3) The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?

1. Respiratory rate 60 and irregular in depth and rhythm
2. Pulse rate 145, cardiac murmur heard
3. Mean blood pressure 55 mm Hg
4. Pauses in respiration lasting 30 seconds

Answer:  4

Explanation:  4. Pauses in respirations greater than 20 seconds are considered episodes of apnea, and require further intervention.

Page Ref: 654

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO:  4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

4) The nurse has assessed four newborns’ respiratory rates immediately following birth. Which respiratory rate would require further assessment by the nurse?

1. 60 breaths per minute
2. 70 breaths per minute
3. 64 breaths per minute
4. 20 breaths per minute

Answer:  4

Explanation:  4. If respirations drop below 20 when the baby is at rest the primary care provider should be notified.

Page Ref: 655

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO:  4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

5) Marked changes occur in the cardiopulmonary system at birth include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Closure of the foramen ovale
2. Closure of the ductus venosus
3. Mean blood pressure of 31 to 61 mmHg in full-term resting newborns
4. Increased systemic vascular resistance and decreased pulmonary vascular resistance
5. Opening of the ductus arteriosus

Answer:  1, 2, 4

Explanation:  1. Closure of the foramen ovale is a function of changing arterial pressures.

2. Closure of the ductus venosus is related to mechanical pressure changes that result from severing the cord, redistribution of blood, and cardiac output.
3. Increased systemic vascular resistance and decreased pulmonary vascular resistance; with the loss of the low-resistance placenta, systemic vascular resistance increases, resulting in greater systemic pressure. The combination of vasodilation and increased pulmonary blood flow decreases pulmonary vascular resistance.

Page Ref: 652, 653

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO:  4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.